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  • 2022-RA-868-ESGO Risk for contralateral non sentinel metastases in patients with a unilateral positive sentinel lymph node in primary vulvar cancer- a subgroup analysis of the AGO-VOP.2 QS vulva study

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Vaginal and vulvar cancer
2022-RA-868-ESGO Risk for contralateral non sentinel metastases in patients with a unilateral positive sentinel lymph node in primary vulvar cancer- a subgroup analysis of the AGO-VOP.2 QS vulva study
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  1. Katharina Prieske1,2,3,
  2. Monika Hampl4,
  3. Anna Jaeger1,
  4. Christine Eulenburg5,
  5. Barbara Schmalfeldt1,
  6. Sophie Fürst6,
  7. Ruediger Klapdor7,
  8. Sabine Heublein8,
  9. Paul Gass9,
  10. Annika Rohner10,
  11. Ulrich Canzler11,
  12. Sven Becker12,
  13. Mareike Bommert13,
  14. Dirk Bauerschlag14,
  15. Agnieszka Denecke15,
  16. Lars Hanker16,
  17. Dirk Runnebaum17,
  18. Dirk M Forner18,
  19. Fabienne Schochter19 and
  20. Linn Woelber1,3
  1. 1Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2Mildred Scheel Cancer Career Center HaTriCS4, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  3. 3Colposcopy Center, Jerusalem Hospital Hamburg, Hamburg, Germany
  4. 4Gynecology, University Medical Center Duesseldorf, Duesseldorf, Germany
  5. 5Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  6. 6Department of Obstetrics and Gynecology, LMU-University of Munich, Munich, Germany
  7. 7Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
  8. 8Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
  9. 9Obstetrics and Gynecology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nurenberg, Erlangen, Germany
  10. 10University Medical Center Tuebingen, Tuebingen, Germany
  11. 11University Hospitial Dresden, Technische Universität Dresden, NCT Partner site Dresden, Dresden, Germany
  12. 12Gynecology and Obstetrics, University Medical Center Frankfurt, Frankfurt, Germany
  13. 13Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
  14. 14Department of Gynecology, University Medical Center Kiel, Kiel, Germany
  15. 15Gynecology, Medical Center Wolfsburg, Wolfsburg, Germany
  16. 16Gynecology and Gynecologic Oncology, University Medical Center Luebeck, Luebeck, Germany
  17. 17Gynecology, Jena University Hospital, Jena, Germany
  18. 18Department of Gynecology, Evangelisches Krankenhaus Kalk, Cologne, Germany
  19. 19University of Ulm Medical Center, Ulm, Germany

Abstract

Introduction/Background The need for contralateral full groin dissection after bilateral sentinelnode biopsy (SNB) with only unilateral detection of a macrometastasis is unclear. Bilateral inguino-femoral lymphadenectomy (if- LAE) is recommended by German guidelines to avoid groin recurrences which are associated with high morbidity. Few unicenter, retrospective analyses have looked at the risk of contralateral non-sentinel (SNL) metastases with conflicting results.

Methodology The AGO VOP.2 QS vulva study is a retrospective,multicenter study. Within the study, therapeutic data from n=306 patients, diagnosed with primary groin node positive vulvar squamous cell carcinoma (VSCC) between 2017–2019 at 33 gynecologic cancer centers in Germany were collected. In the current subgroup analysis, only patients with bilateral SNB and unilateral positive SNL were included.

Results Of 306 documented groin node positive patients, 137 received bilateral SNB. Of these, 98 had unilateral positive SNL.58/98 (59.18%) received a consecutive bilateral if- LAE. 30/98 (30.61%) underwent unilateral if- LAE and 10/98 (10.2%) had none. Of 98 patients with unilateral positive SNL, two patients (2.04%) showed positive contralateral non-SNL. In the first patient with a midline VSCC a contralateral non-SNL metastasis was detected, despite two negative SNLs in this groin. Bilateral LAE and adjuvant chemoradiation of groins and pelvis were performed and there is no sign of recurrence 18 months after first diagnosis (FD). In the second patient one non-SNL metastasis of 2 mm was detected during LAE after a negative SNL node in the same groin. This patient received radiation to vulva and groins. She suffered from isolated groin recurrence in the groin were the SNL metastasis was initially detected, 11 months after FD.

Conclusion In this large multicentre retrospective trial the risk of contralateral non-SNL metastasis is low. Therefore, morbidity should be carefully balanced against oncologic safety and omission of contralateral LAE should be considered, especially in multimorbid or obese patients.

https://doi.org/10.1136/ijgc-2022-ESGO.934

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